From the Guidelines
Red yeast rice has been shown to lower LDL cholesterol levels, with possible bioactive effects related to a statin-like mechanism, inhibiting hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, as noted in the 2011 European Heart Journal study 1. The effect of Red Yeast Rice (RYR) on Low-Density Lipoprotein (LDL) cholesterol levels is attributed to its monacolin content, which has a statin-like mechanism of action.
- Key points to consider:
- RYR has been used for centuries in China as a food colourant and flavour enhancer
- Different commercial preparations of RYR have different concentrations of monacolins, the bioactive ingredients
- One RCT from China in patients with CAD showed that a partially purified extract of RYR reduced recurrent events by 45% 1
- When considering the use of RYR to lower LDL cholesterol levels, it is essential to:
- Consult with a healthcare provider, especially if you're already taking cholesterol medications
- Monitor cholesterol levels and liver function regularly while using this supplement
- Be aware of potential side effects, including muscle pain and liver enzyme elevation, similar to those of prescription statins
- The long-term safety of regular consumption of RYR products is not fully documented, and product potency varies widely between brands since monacolin content isn't standardized or regulated, as highlighted in the 2011 European Heart Journal study 1.
From the Research
Effect of Red Yeast Rice on LDL Cholesterol Levels
- Red Yeast Rice (RYR) has been shown to reduce Low-Density Lipoprotein (LDL) cholesterol levels by approximately 15-34% versus placebo 2, 3, 4.
- The main cholesterol-lowering component of RYR is monacolin K, which is structurally identical to lovastatin and targets the same key enzyme of cholesterol biosynthesis 3.
- Daily consumption of 3-10 mg of monacolin K has been found to reduce LDL cholesterol plasma levels by 15-25% within 6-8 weeks 2, 4.
- RYR supplementation has also been found to reduce total cholesterol, non-high-density lipoprotein cholesterol, plasma apolipoprotein B, and high-sensitivity C-reactive protein levels 2, 4.
Tolerability and Safety of Red Yeast Rice
- RYR has been found to be well-tolerated, with minimal associated risks, and mild myalgias are seen only in the frailest patients 2, 4.
- A daily dose of RYR that provides about 3 mg/d of monacolin K is well-tolerated, with an adverse event profile similar to that of low-dose statins 3.
- RYR may be a treatment option for lowering LDL cholesterol levels and ASCVD risk for people with mild-to-moderate hypercholesterolemia who are ineligible for statin therapy 3.
Clinical Trials and Studies
- A randomized trial found that RYR decreased LDL cholesterol level by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24 5.
- A study of 25 patients treated with RYR found that total cholesterol decreased 15% and LDL cholesterol decreased 21% during 74 +/- 39 days of treatment 6.
- A narrative review found that RYR supplementation reduces LDL-C levels by approximately 15-34% versus placebo, with a similar effect to low-dose, first-generation statins in subjects with mild-to-moderate dyslipidemia 3.